Is Depression at the Root of the Opioid Epidemic?

A record 502 Long Islanders died from opioid overdose in 2016, according to Nassau and Suffolk County medical officials. And for the first time, fentanyl outpaced heroin as the deadliest drug on Long Island with at least 242 deaths tied to the painkiller. Could depression be playing a major role in the epidemic?

As a resident psychiatrist, I’ve seen the effects of opioid addiction on one’s physical and mental health. There’s a saying in recovery, “mental illness doesn’t cause drug addiction, but drug addiction can cause mental illness.” New research suggests otherwise. Physiciansand researchers believe an undisclosed diagnosis of Major Depressive Disorder may cause patients to misuse opioids if they have a coexisting pain syndrome.

What’s the real link between opioids and depression? There are a few hypothesis, but think of opioids as treating the emotional toll of depression, rather than simply chronic physical pain symptoms. Opioids target the mu receptors, which can be responsible for the chronic pain disorder symptoms like insomnia and stress. Although drugs that act directly on the mu receptors (like opioids) are not the primary treatment for Major Depressive Disorder, they provide temporary feelings of euphoria and stress release for people who are battling both depression and pain symptoms.

And that can set off a ripple effect. Depressed people who do not receive appropriate treatment with an antidepressant medication are likely to keep self-medicating with opioids even after the cause of their pain symptoms had been treated, according to a 2015 study in The Journal of Pain. The study investigated the association between opioid use, pain and depression among 2,102 people in a university based pain clinic. It concluded that in non-depressed patients, opioid use only increased as pain increased and functioning decreased. On the other hand, depressed individuals were likely to continue using opioids regardless of their levels of pain or functioning. The findings support the theory that depressed patients can use opioids to treat their emotional pain symptoms and disprove the old recovery adage.

Addiction and depression are both treatable. drugabuse.gov offers advice and information for families battling addiction. Locally, the Long Island Addiction services phone number is 855-572-0743. The LICADD 24/7 hotline for Suffolk County is631-979-1700.

Long Island Pulse will be exploring the continued rise of opioid use on Long Island in June on lipulse.com. Check back for interviews with advocates and therapists on the front lines of the crisis and a look at how fentanyl became the deadliest drug on Long Island.